A: As a low-vision rehabilitation optometrist, I work with both patients and other rehabilitation professionals to coordinate services for people who are legally blind and visually impaired. The patients I see cannot see well, either due to loss of peripheral vision or loss of visual acuity, and glasses will not correct for their problems.

Low-vision rehabilitation teaches patients how to use their vision or other senses to complete whatever their goals are. Each patient is different, so goals might range from safely making a skydive to cooking dinner with limited visual acuity, and the initial evaluation with the low-vision optometrist helps patients to set goals, teach them the skill sets needed to work toward those goals, teach the patient about their eye conditions and prognosis and connect the patient with other professionals as needed. Other professionals may include occupational therapists, case workers, orientation and mobility instructors (use of cane and/or guide dog), specialized driving programs or social workers. Low-vision optometrists often help with IEPs [individual education plans] for students with visual impairments, on the job modifications and patient advocacy as well. 

Q: What type of education and training does a low-vision specialist have? 

A: There are different types of low-vision specialists. Most have a master’s degree in low vision rehabilitation, orientation and mobility or other specialty. Some have professional degrees in other areas and subspecialized from there. I took both avenues, with both an optometry degree as well as a master’s in low-vision rehabilitation. 

Q: What typically occurs during a low-vision consultation? Is it more involved than a regular eye exam? 

A: Generally, I try to call patients before their appointments for an intake. This consists of a general medical history, general eye history, letting the patient know what to bring with them to the exam and what to expect when they get here.

Generally, low-vision exams last 45 minutes to two hours, depending on the patient, the vision, the goals and the visual needs, as well as any additional training given in the office. Follow-up care is important, too, as patients are learning new ways to use their vision and manipulate their environments in order to meet their own individual goals.

During the actual initial evaluation, the patient has their glasses prescription checked, but in a much longer method than traditionally used, and often using a “trial frame,” which allows the patient much greater ability to use their peripheral vision and make the refraction more accurate for those with vision loss.

Based on the refraction, vision and goals, low vision aids are then introduced, to determine which avenues are most comfortable and effective for the patient. Next, patients are taught how to use their low vision aids. Finally, follow-up care, which may include seeing the optometrist again, home visits to help modify the environment and referrals as needed to other professionals are made. Questions are highly encouraged throughout the exam, and it is generally best to bring a friend or family member along for a second pair of ears. 

Services may include training with the aids, case workers to help with social or other problematic areas, specialized driving programs if safe for the patient, support groups, occupational or physical therapists, orientation and mobility instructors, or a host of other services. 

Q: What is your favorite part of working as a low-vision specialist and what is your biggest challenge?

A: My favorite part of working with low vision patients is getting to know them and their families. Since the evaluation lasts so much longer than a typical eye exam and often involves follow-up care and training, it is very personal. I also love the joy when a patient masters a new skill, writes her name for the first time or learns how to recognize faces more easily. It is an extremely rewarding profession.

The biggest challenge for me is “I can’t” syndrome. Low vision evaluations are all about the patient learning new skills, and some patients defeat themselves with “I can’t.” Motivation and positive attitude does help, but in the end, it’s the patient who has to work hard to reach their goals. As low vision specialists, we just help to guide them on their way. 